1-4 interfere with any communication between a provider of health care and

1-5 an injured employee regarding any information that the provider of

1-6 health care determines is relevant to the health care of the injured

2-2 contract with, demote, refuse to contract with or refuse to compensate a

2-3 provider of health care solely because the provider, in good faith:

2-4 1. Advocates in private or in public on behalf of an injured

2-5 employee;

2-6 2. Assists an injured employee in seeking reconsideration of a

2-7 determination by the organization for managed care to deny coverage for

2-8 a medical or health care service; or

2-11 any type of material inducement, bonus or other financial incentive to a

2-12 provider of health care to deny, reduce, withhold, limit or delay specific

2-13 medically necessary medical or health care services to an injured

2-14 employee.

2-15 2. The provisions of this section do not prohibit an arrangement for

2-16 payment between an organization for managed care and a provider of

2-17 health care that uses financial incentives, if the arrangement is designed

2-18 to provide an incentive to the provider of health care to use medical and

2-19 health care services effectively and consistently in the best interest of the

2-23 manager may enter into a contract or contracts with one or more

2-24 organizations for managed care, including health maintenance

2-25 organizations, to provide comprehensive medical and health care services

2-26 to injured employees whose employers are insured by the system for

2-27 injuries and diseases that are compensable under chapters 616A to 617,

2-28 inclusive, of NRS. The contract or contracts must be awarded pursuant to

2-29 reasonable competitive bidding procedures as established by the manager.

2-30 2. After the selection of an organization for managed care, the bids

2-31 received by the manager and the records related to the bidding are subject

2-32 to review by any member of the public upon request.

2-33 3. An organization for managed care or a health maintenance

2-34 organization [shall] chosen pursuant to this section:

2-35 (a) Shall not discriminate against or exclude a provider of health care

2-36 from participation in the organization’s proposed plan for providing

2-37 medical and health care services because of race, creed, sex, national

2-38 origin, age or disability.

4-10 and chiropractors who have demonstrated special competence and interest

4-11 in industrial health to treat injured employees under chapters 616A to

4-12 616D, inclusive, or chapter 617 of NRS. Every employer whose insurer has

4-13 not entered into a contract with an organization for managed care or with

4-14 providers of health care services pursuant to NRS 616B.515 or 616B.527

4-15 shall maintain a list of those physicians and chiropractors on the panel who

4-16 are reasonably accessible to his employees.

4-17 2. An injured employee whose employer’s insurer has not entered into

4-18 a contract with an organization for managed care or with providers of

4-19 health care services pursuant to NRS 616B.515 or 616B.527 may choose

4-20 his treating physician or chiropractor from the panel of physicians and

4-21 chiropractors. If the injured employee is not satisfied with the first

4-22 physician or chiropractor he so chooses, he may make an alternative choice

4-23 of physician or chiropractor from the panel if the choice is made within 90

4-24 days after his injury. The insurer shall notify the first physician or

4-25 chiropractor in writing. The notice must be postmarked within 3 working

4-26 days after the insurer receives knowledge of the change. The first physician

4-27 or chiropractor must be reimbursed only for the services he rendered to the

4-28 injured employee up to and including the date of notification. Any further

4-29 change is subject to the approval of the insurer, which must be granted or

4-30 denied within 10 days after a written request for such a change is received

4-31 from the injured employee. If no action is taken on the request within 10

4-32 days, the request shall be deemed granted. Any request for a change of

4-33 physician or chiropractor must include the name of the new physician or

4-34 chiropractor chosen by the injured employee.

4-35 3. An injured employee [employed or residing in any county in this

4-36 state] whose employer’s insurer has entered into a contract with an

4-37 organization for managed care or with providers of health care services

4-38 pursuant to NRS 616B.515 or 616B.527 must choose his treating

4-39 physician or chiropractor pursuant to the terms of that contract. If the

4-40 injured employee is not satisfied with the first physician or chiropractor

4-41 he so chooses, he may make an alternative choice of physician or

4-42 chiropractor pursuant to the terms of the contract if the choice is made

5-24 of chapters 616A to 616D, inclusive, or chapter 617 of NRS for an injury:

5-25 (a) Caused by the employee’s willful intention to injure himself.

5-26 (b) Caused by the employee’s willful intention to injure another.

5-27 (c) Proximately caused by the employee’s intoxication. If the employee

5-28 was intoxicated at the time of his injury, intoxication must be presumed to

5-29 be a proximate cause unless rebutted by evidence to the contrary.

5-30 (d) Proximately caused by the employee’s use of a controlled substance.

5-31 If the employee had any amount of a controlled substance in his system at

5-32 the time of his injury for which the employee did not have a current and

5-33 lawful prescription issued in his name, the controlled substance must be

5-34 presumed to be a proximate cause unless rebutted by evidence to the

5-35 contrary.

5-36 2. For the purposes of paragraphs (c) and (d) of subsection 1:

5-37 (a) The affidavit or declaration of an expert or other person described in

5-38 NRS 50.315 is admissible to prove the existence of any alcohol or the

5-39 existence, quantity or identity of a controlled substance in an employee’s

5-40 system. If the affidavit or declaration is to be so used, it must be submitted

5-41 in the manner prescribed in NRS 616C.355.

5-42 (b) When an examination requested or ordered includes testing for the

6-32 person who is aggrieved by a [decision] final determination concerning

6-33 accident benefits made by an organization for managed care which has

6-34 contracted with an insurer must, within 14 days of the [decision]

6-35 determination and before requesting a resolution of the dispute pursuant to

6-36 NRS 616C.345 to 616C.385, inclusive, appeal that [decision]

6-37 determination in accordance with the procedure for resolving complaints

6-38 established by the organization for managed care.

6-39 2. The procedure for resolving complaints established by the

6-40 organization for managed care must be informal and must include, but is

6-41 not limited to, a review of the appeal by a qualified physician or

6-42 chiropractor who did not make or otherwise participate in making the

7-8 (a) Within 5 days after receiving a request for a hearing, set the hearing

7-9 for a date and time within 30 days after his receipt of the request;

7-10 (b) Give notice by mail or by personal service to all interested parties to

7-11 the hearing at least 15 days before the date and time scheduled; and

7-12 (c) Conduct hearings expeditiously and informally.

7-13 2. The notice must include a statement that the injured employee may

7-14 be represented by a private attorney or seek assistance and advice from the

7-15 Nevada attorney for injured workers.

7-16 3. If necessary to resolve a medical question concerning an injured

7-17 employee’s condition [,] or to determine the necessity of treatment for

7-18 which authorization for payment has been denied, the hearing officer may

7-19 refer the employee to a physician or chiropractor [chosen by the hearing

7-20 officer.] of his choice who has demonstrated special competence to treat

7-21 the particular medical condition of the employee. If the medical question

7-22 concerns the rating of a permanent disability, the hearing officer may refer

7-23 the employee to a rating physician or chiropractor. The rating physician or

7-24 chiropractor must be selected in rotation from the list of qualified

7-25 physicians and chiropractors maintained by the administrator pursuant to

7-26 subsection 2 of NRS 616C.490, unless the insurer and injured employee

7-27 otherwise agree to a rating physician or chiropractor. The insurer shall pay

7-28 the costs of any medical examination requested by the hearing officer.

7-29 4. The hearing officer may allow or forbid the presence of a court

7-30 reporter and the use of a tape recorder in a hearing.

7-31 5. The hearing officer shall render his decision within 15 days after:

7-32 (a) The hearing; or

7-33 (b) He receives a copy of the report from the medical examination he

7-34 requested.

7-35 6. The hearing officer shall render his decision in the most efficient

7-36 format developed by the chief of the hearings division of the department of

7-37 administration.

7-38 7. The hearing officer shall give notice of his decision to each party by

7-39 mail. He shall include with the notice of his decision the necessary forms

7-40 for appealing from the decision.

7-41 8. Except as otherwise provided in NRS 616C.380, the decision of the

7-42 hearing officer is not stayed if an appeal from that decision is taken unless

8-9 relating to a claim for compensation may appeal from the decision by filing

8-10 a notice of appeal with an appeals officer within 30 days after the date of

8-11 the decision.

8-12 2. If a dispute is required to be submitted to a procedure for resolving

8-13 complaints pursuant to NRS 616C.305 and:

8-14 (a) A final [decision] determination was rendered pursuant to that

8-15 procedure; or

8-16 (b) The dispute was not resolved pursuant to that procedure within 14

8-17 days after it was submitted,

8-18 any party to the dispute may file a notice of appeal within 70 days after the

8-19 date on which the final [decision] determination was mailed to the

8-20 employee, or his dependent, or the unanswered request for resolution was

8-21 submitted. Failure to render a written [decision] determination within 30

8-22 days after receipt of such a request shall be deemed by the appeals officer

8-23 to be a denial of the request.

8-24 3. Except as otherwise provided in NRS 616C.380, the filing of a

8-25 notice of appeal does not automatically stay the enforcement of the decision

8-26 of a hearing officer or a [decision] determination rendered pursuant to

8-27 NRS 616C.305. The appeals officer may order a stay, when appropriate,

8-28 upon the application of a party. If such an application is submitted, the

8-29 decision is automatically stayed until a determination is made concerning

8-30 the application. A determination on the application must be made within 30

8-31 days after the filing of the application. If a stay is not granted by the officer

8-32 after reviewing the application, the decision must be complied with within

8-33 10 days after the date of the refusal to grant a stay.

8-34 4. Except as otherwise provided in this subsection, the appeals officer

8-35 shall, within 10 days after receiving a notice of appeal pursuant to this

8-36 section or a contested claim pursuant to subsection 5 of NRS 616C.315,

8-37 schedule a hearing on the merits of the appeal or contested claim for a date

8-38 and time within 90 days after his receipt of the notice and give notice by

8-39 mail or by personal service to all parties to the matter and their attorneys or

8-40 agents at least 30 days before the date and time scheduled. A request to

8-41 schedule the hearing for a date and time which is:

8-42 (a) Within 60 days after the receipt of the notice of appeal or contested

9-14 hearing before the appeals officer and the rules of evidence applicable to

9-15 contested cases under chapter 233B of NRS apply to the hearing.

9-16 2. The appeals officer must hear any matter raised before him on its

9-17 merits, including new evidence bearing on the matter.

9-18 3. If necessary to resolve a medical question concerning an injured

9-19 employee’s condition [,] or to determine the necessity of treatment for

9-20 which authorization for payment has been denied, the appeals officer may

9-21 refer the employee to a physician or chiropractor [chosen by the appeals

9-22 officer.] of his choice who has demonstrated special competence to treat

9-23 the particular medical condition of the employee. If the medical question

9-24 concerns the rating of a permanent disability, the appeals officer may refer

9-25 the employee to a rating physician or chiropractor. The rating physician or

9-26 chiropractor must be selected in rotation from the list of qualified

9-27 physicians or chiropractors maintained by the administrator pursuant to

9-28 subsection 2 of NRS 616C.490, unless the insurer and the injured employee

9-29 otherwise agree to a rating physician or chiropractor. The insurer shall pay

9-30 the costs of any examination requested by the appeals officer.

9-31 4. Any party to the appeal or the appeals officer may order a transcript

9-32 of the record of the hearing at any time before the seventh day after the

9-33 hearing. The transcript must be filed within 30 days after the date of the

9-34 order unless the appeals officer otherwise orders.

9-35 5. The appeals officer shall render his decision:

9-36 (a) If a transcript is ordered within 7 days after the hearing, within 30

9-37 days after the transcript is filed; or

9-38 (b) If a transcript has not been ordered, within 30 days after the date of

9-39 the hearing.

9-40 6. The appeals officer may affirm, modify or reverse any decision

9-41 made by the hearing officer and issue any necessary and proper order to

10-10 section 13 of this act, unless the context otherwise requires, the words and

10-11 terms defined in NRS 686B.1752 to 686B.1762, inclusive, and section 13

10-15 1. Develop statistical plans including definitions for the classification

10-16 of risks.

10-17 2. Collect statistical data from its members and subscribers or any

10-18 other reliable source.

10-19 3. Prepare and distribute data on [the basic premium rate or rates,

10-20 adjusted for expected changes in reported losses and for trends in losses,

10-21 according to its statistical plan.] prospective loss costs.

10-22 4. Prepare and distribute manuals of rules and schedules for rating

10-23 which do not permit calculating the final rates without using information

10-24 other than the information in the manual.

10-25 5. Distribute any information filed with the commissioner which is

10-26 open to public inspection.

10-27 6. Conduct research and collect statistics to discover, identify and

10-28 classify information on the causes and prevention of losses.

10-29 7. Prepare and file forms and endorsements for policies and consult

10-30 with its members, subscribers and any other knowledgeable persons on

10-31 their use.

10-32 8. Collect, compile and distribute information on the past and current

10-33 premiums charged by individual insurers if the information is available for

10-34 public inspection.

10-35 9. Conduct research and collect information to determine what effect

10-36 changes in benefits to injured employees pursuant to chapters 616A to 617,

10-37 inclusive, of NRS will have on [the basic premium rate or rates.]

10-38 prospective loss costs.

10-39 10. Prepare and distribute rules and rating values for the uniform plan

10-40 for rating experience.

10-41 11. Calculate and provide to the insurer the modification of premiums

11-6 commissioner a copy of every basic premium rate, the portion of the rate

11-7 that is allowable for expenses as determined by the advisory organization,

11-8 every manual of rating rules, every rating schedule and every change,

11-9 amendment or modification to them which is proposed for use in this state

11-10 at least 60 days before they are distributed to the organization’s members,

11-11 subscribers or other persons. The rates shall be deemed to be approved

11-12 unless they are disapproved by the commissioner within 60 days after they

11-13 are filed.

11-14 2. The commissioner shall report any changes in rates or in the uniform

11-15 plan for rating experience, the uniform statistical plan or the uniform

11-16 system of classification, when approved, to the director of the legislative

11-17 counsel bureau.

11-18 3. The rates filed by the advisory organization and approved by the

11-19 commissioner apply to every insurer. In no case may an insurer’s rate be

11-20 less than the approved rate by more than the following percentages:

11-21 (a) For the period beginning on July 1, 1999, and ending on June 30,

11-22 2000, no variance.

11-23 (b) For the period beginning on July 1, 2000, and ending on June 30,

11-24 2001, no more than a [5] 15 percent variance.

11-25 [(c) For the period beginning on July 1, 2001, and ending on June 30,

11-26 2002, no more than a 10 percent variance.

11-27 (d) For the period beginning on July 1, 2002, and ending on June 30,

11-31 commissioner a copy of every [basic premium rate,] prospective loss cost,

11-32 every manual of rating rules, every rating schedule and every change,

11-33 amendment or modification to them which is proposed for use in this state

11-34 at least 60 days before they are distributed to the organization’s members,

11-35 subscribers or other persons. The rates shall be deemed to be approved

11-36 unless they are disapproved by the commissioner within 60 days after they

11-37 are filed.

11-38 2. The commissioner shall report any changes in rates or in the uniform

11-39 plan for rating experience, the uniform statistical plan or the uniform

11-40 system of classification, when approved, to the director of the legislative

12-3 presumed or found to be competitive, each] Each insurer shall file with the

12-4 commissioner all the rates , [and] supplementary rate information,

12-5 supporting data, and changes and amendments thereof, except any

12-6 information filed by the advisory organization, which the insurer intends to

12-7 use in this state. [The insurer shall file the rates and supplementary rate

12-8 information] An insurer may adopt by reference any supplementary rate

12-9 information or supporting data that has been previously filed by that

12-10 insurer and approved by the commissioner. The filing must indicate the

12-11 date the rates will become effective. An insurer may file its rates pursuant

12-12 to this subsection by filing:

12-13 (a) Final rates; or

12-14 (b) A multiplier and, if used by an insurer, a premium charged to each

12-15 policy of industrial insurance regardless of the size of the policy which,

12-16 when applied to the prospective loss costs filed by the advisory

12-17 organization pursuant to NRS 686B.177, will result in final rates.

12-18 2. Each insurer shall file the rates, supplementary rate information

12-19 and supporting data pursuant to subsection 1:

12-20 (a) Except as otherwise provided in subsection 4, if the interaction

12-21 among insurers and employers is presumed or found to be competitive,

12-22 not later than 15 days [after] before the date the rates become effective.

12-23 [An insurer may adopt by reference, with or without a deviation, the rates

12-24 or supplementary rate information filed by any other insurer.

12-25 2.] (b) If the commissioner has issued a finding that the interaction is not

12-26 competitive, [each insurer shall file with the commissioner all the rates and

12-27 supplementary rate information, except for the information filed by the

12-28 advisory organization, at least] not later than 60 days before the rates

12-29 become effective.

12-30 3. If the information supplied by an insurer pursuant to [this]

12-31 subsection 1 is insufficient, the commissioner shall notify the insurer and

12-32 [the information shall be deemed to be filed when] require the insurer to

12-33 provide additional information. The filing must not be deemed complete

12-34 or available for use by the insurer and review by the commissioner must

12-35 not commence until all the information requested by the commissioner is

12-36 received by him.

12-37 [3.] If the requested information is not received by the commissioner

12-38 within 60 days after its request, the filing may be disapproved without

12-39 further review.

12-40 4. If, after notice to the insurer and a hearing, the commissioner finds

12-41 that an insurer’s rates require supervision because of the insurer’s financial

13-21 (a) The interaction among insurers is not competitive;

13-22 (b) The rates filed by insurers whose interaction is competitive are

13-23 inadequate or unfairly discriminatory; or

13-24 (c) The rates violate the provisions of this chapter,

13-25 the commissioner may require the insurers to file information supporting

13-26 their existing rates. Before the commissioner may disapprove those rates,

13-27 he shall notify the insurers and hold a hearing on the rates and the

13-28 supplementary rate information.

13-29 2. The commissioner may disapprove any rate [which must be filed

13-30 before it becomes effective] without a hearing. Any insurer whose rates are

13-31 disapproved in this manner may request in writing and within 30 days after

13-35 insurer [:

13-36 (a) At any time after the rate becomes effective; or

13-37 (b) At] at any time . [before the rate becomes effective.]

13-38 2. The commissioner shall disapprove a rate if:

13-39 (a) An insurer has failed to meet the requirements for filing a rate

13-40 pursuant to this chapter or the regulations of the commissioner; or

14-3 insurer [:

14-4 (a) At any time after the rate becomes effective; or

14-5 (b) At] at any time . [before the rate becomes effective if the insurer is

14-6 required to file its rates before they become effective.]

14-7 2. The commissioner shall disapprove a rate if:

14-8 (a) An insurer has failed to meet the requirements for filing a rate

14-9 pursuant to this chapter or the regulations of the commissioner;

14-10 (b) The rate is inadequate or unfairly discriminatory and the interaction

14-11 among insurers and employers is competitive; or

14-12 (c) A rate is inadequate, excessive or unfairly discriminatory and the

14-13 commissioner has found and issued an order that the interaction among the

14-17 organization or plan for apportioned risks whenever he determines that

14-18 such an examination is necessary.

14-19 2. The reasonable cost of an examination must be paid by the insurer

14-20 or other person examined upon presentation by the commissioner of an

14-21 accounting of those costs pursuant to NRS 679B.290.

14-22 3. In lieu of an examination, the commissioner may accept the report of

14-23 an examination made by the agency of another state that regulates

14-27 provision of NRS 686B.1751 to 686B.1799, inclusive, and section 13 of

14-28 this act shall, upon the order of the commissioner, pay an administrative

14-29 fine not to exceed $1,000 for each violation and not to exceed $10,000 for

14-30 each willful violation. These administrative fines are in addition to any

14-31 other penalty provided by law. Any insurer using a rate before it has been

14-32 filed with the commissioner as required by NRS 686B.1775, shall be

14-33 deemed to have committed a separate violation for each day the insurer

14-34 failed to file the rate.

14-35 2. The commissioner may suspend or revoke the license of any

14-36 advisory organization or insurer who fails to comply with an order within

14-37 the time specified by the commissioner or any extension of that time made

14-38 by the commissioner. Any suspension of a license is effective for the time

14-39 stated by the commissioner in his order or until the order is modified,

14-40 rescinded or reversed.

14-41 3. The commissioner, by written order, may impose a penalty or

14-42 suspend a license pursuant to this section only after written notice to the

15-5 86, 119, 127, 128, 186.5, 188, 194, 195 and 196 of this act become

15-6 effective upon passage and approval.

15-7 2. Section 68 of this act becomes effective at 12:01 a.m. on

15-8 July 1, 1995.

15-9 3. Section 161 of this act becomes effective on July 1, [2003.]

15-10 2001.

15-11 4. The remaining sections of this act become effective:

15-12 (a) Upon passage and approval for the purposes of:

15-13 (1) The adoption of regulations by the commissioner of

15-14 insurance and the administrator of the division of industrial

15-15 relations of the department of business and industry.

15-16 (2) The qualification of private carriers to sell industrial

15-17 insurance.

15-18 (3) The designation of a licensed advisory organization by the

15-19 commissioner and the initial filing of classifications of risk, the

15-20 uniform plan for rating experience and the uniform statistical plan,

15-21 by that organization.

15-22 (4) The inspection of the records of the system, the Nevada

15-23 industrial commission and the administrator with respect to the self-

15-24 insured employers, by the commissioner and the advisory

15-25 organization.

15-26 (5) The filing, by private carriers and the system, of rates to be

15-27 used by them.